Provider Demographics
NPI:1881916393
Name:KIMBROUGH, SHARLA BROWN (PT)
Entity type:Individual
Prefix:MS
First Name:SHARLA
Middle Name:BROWN
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHARLA
Other - Middle Name:GAYLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7710 BELUCHE DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1522
Mailing Address - Country:US
Mailing Address - Phone:409-771-2469
Mailing Address - Fax:
Practice Address - Street 1:7710 BELUCHE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1522
Practice Address - Country:US
Practice Address - Phone:409-771-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist